Medical Coding Revenue Calculator
Expected reimbursement from CPT codes and fee schedule.
About this calculator
This calculator projects a practice's blended E&M revenue from its own visit-level coding mix rather than a single average fee, because the split across Level 3 (99213), Level 4 (99214), and Level 5 (99215) visits changes the blended rate far more than most single-lever fixes on a fee schedule. Total visits per month is the input the projection is most sensitive to — doubling volume roughly doubles monthly and annual revenue, since every downstream dollar figure scales off it. Payer mix matters too: raising the commercial payer multiplier (typically 1.2-1.8x Medicare) lifts revenue in direct proportion to how much of the panel is commercially insured, which is why a practice with a richer commercial mix can carry a lighter visit volume than one that is mostly Medicare and Medicaid. The Coding accuracy input is deliberately isolated from the revenue total itself — it does not change Monthly expected revenue at all, because the model does not know what the "correct" level should have been.
Instead it drives a separate Coding improvement opportunity figure, built on an assumption that roughly 30% of miscoded Level 4 visits downcode to Level 3 and 20% of miscoded Level 5 visits downcode to Level 4. One real limitation worth naming: the model has no visibility into your actual payer contract terms, does not model bundled or global payment periods, and treats "other CPT codes" as a single flat average rather than itemized procedures. The wRVU output is a simple visit-weighted sum using standard CMS work RVU values (unchanged since CY2021) for the three E&M levels plus a placeholder for other codes, useful for a rough productivity cross-check but not a substitute for your actual CPT-level wRVU report.
Medical Disclaimer
This calculator is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions about your health. Never disregard professional medical advice or delay seeking it because of results from this tool.
Inputs
Results
Monthly expected revenue
$59,576.00
Annual expected revenue
$714,917.00
How to Use This Calculator
- Enter Total visits per month and distribute the E&M visit mix across % Level 3 (99213), % Level 4 (99214), and % Level 5 (99215).
- Set % Other CPT codes and Avg other CPT reimbursement for procedures, injections, or ancillary services.
- Enter Commercial payer multiplier (typically 1.2–1.8×) and Commercial payer mix (%) to blend Medicare and commercial rates.
- Set Coding accuracy (%) — at 85% accuracy, the Coding improvement opportunity output shows recoverable revenue.
- Review Monthly expected revenue and Annual expected revenue as your baseline projection for budgeting.
- Use Annual wRVUs generated to compare provider productivity against MGMA specialty benchmarks.
How the result changes with Total visits per month
| Total visits per month | Monthly expected revenue | Annual expected revenue |
|---|---|---|
| 200 | $29,788.00 | $357,458.00 |
| 300 | $44,682.00 | $536,188.00 |
| 600 | $89,365.00 | $1,072,375.00 |
| 1,000 | $148,941.00 | $1,787,292.00 |
What each input means
- Total visits per month
- Total patient encounters per month across all providers.
- % Level 3 (99213)
- Percentage of E&M visits coded at Level 3 (low complexity).
- % Level 4 (99214)
- Percentage of E&M visits coded at Level 4 (moderate complexity).
- % Level 5 (99215)
- Percentage of E&M visits coded at Level 5 (high complexity).
- % Other CPT codes
- Percentage of visits with procedures, injections, or non-E&M codes.
- Avg other CPT reimbursement ($)
- Average Medicare reimbursement for non-E&M CPT codes.
- Commercial payer multiplier
- Commercial reimbursement as a multiple of Medicare (typically 1.2-1.8x).
- Commercial payer mix (%)
- Percentage of patients with commercial insurance.
- Coding accuracy (%)
- Percentage of visits coded at the correct E&M level.
What each result means
- Monthly expected revenue
- Total blended reimbursement per month.
- Annual expected revenue
- Projected annual reimbursement.
- Avg revenue per visit
- Blended average collection per encounter.
- Annual wRVUs generated
- Total work RVUs from the visit mix.
- Coding improvement opportunity
- Estimated annual revenue gained by improving coding accuracy to 100%.
- Blended rate: Level 3
- Payer-mix weighted reimbursement for 99213.
- Blended rate: Level 4
- Payer-mix weighted reimbursement for 99214.
- Blended rate: Level 5
- Payer-mix weighted reimbursement for 99215.
How this is calculated
Worked example, using the default values
- Identify Input Parameters4 parametersTotal visits per month = 400, % Level 3 (99213) = 30, % Level 4 (99214) = 50, % Level 5 (99215) = 15 = 9 input(s) provided
- Calculate Monthly expected revenueMonthly expected revenue = visitsL3 * blendedL3 + visitsL4 * blendedL4 +59576 = $59,576
- Calculate Annual expected revenueAnnual expected revenue = monthlyRevenue * 12714917 = $714,917
- Calculate Avg revenue per visitAvg revenue per visit = monthlyRevenue / max(1, totalVisitsPerMonth)148.94 = $148.94
- Calculate Annual wRVUs generatedAnnual wRVUs generated = totalWRVUs * 128856 = 8856
Engine last updated . Checked against 2 independently-derived tests — how we verify calculators. Built by Paul Gunder, a software engineer, not a licensed financial, medical, or legal professional.
Frequently Asked Questions
Why doesn't raising coding accuracy change the monthly revenue total?
Monthly expected revenue is built entirely from the visit counts and percentages you enter for each E&M level — it takes your coding mix as given and prices it out. Coding accuracy instead feeds a separate Coding improvement opportunity output, which estimates what additional revenue might be recoverable if some of the Level 4 and Level 5 visits that are currently downcoded were billed correctly. The two figures answer different questions: one is what your current documented mix is worth, the other is what accuracy improvement might be worth on top of it.
What drives the blended reimbursement rate more, payer mix or visit complexity?
Both matter, but they interact rather than compete. Visit complexity (the Level 3/4/5 split) sets the base Medicare rate per visit, while the commercial payer multiplier and commercial payer mix scale that base upward for the portion of the panel with commercial insurance. A practice that is 80% Level 4/5 visits with a low commercial mix can generate less blended revenue per visit than a Level 3-heavy practice with a strong commercial payer base, because the multiplier applies on top of whatever base rate the coding mix produces.
How is the annual wRVU figure calculated, and can I use it for compensation planning?
Annual wRVUs sums each visit level's count times its standard work RVU value (1.30 for Level 3, 1.92 for Level 4, 2.80 for Level 5, plus a fixed 1.5 placeholder for other CPT codes), then annualizes the monthly total. It is a reasonable planning estimate for comparing volume across providers or against typical benchmark ranges, but real compensation formulas should use your actual coded wRVUs per CPT code from your billing system, since the "other CPT" placeholder value here is not itemized.
Does the calculator distinguish between Medicare, Medicaid, and self-pay rates?
No — this model only splits reimbursement into Medicare-baseline and a single blended commercial rate, weighted by the commercial payer mix percentage you enter. Everything that isn't commercial is treated as reimbursing at the Medicare baseline rate, which will overstate revenue for practices with a meaningful Medicaid or self-pay population, since those typically reimburse below Medicare. If your payer mix includes significant Medicaid or self-pay volume, treat the output as an upper bound rather than a precise blended figure.
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